ROUX-EN-Y GASTRIC BYPASS

What is a Roux-En-Y gastric bypass?Gastric bypass is a surgery that reduces the size of your stomach so that it can no longer hold a large amount of food. At the same time the surgery creates a much smaller opening out of the stomach so that it takes longer for food to empty into the intestine. The surgery bypasses certain portions of the intestine so that absorption of nutrients is more difficult.

How is the decision made that surgery is needed?Adolescents participate in a weight management program for several months and work with psychologists, nutritionists, exercise specialists, nurses and doctors. If the adolescent is unable to lose weight with medical therapy, still has an obesity related disease and has shown that they have learned about nutrition and exercise then they are candidates for gastric bypass.

What can I expect from surgery? You can expect to lose about 33% of your excess body weight the first year. The weight loss frequently improves overall health and quality of life and also increases life expectancy.

What do I need to do after the operation? For this operation to work, you will need to continue on your diet plan, exercise plan and take your medicines for the rest of your life. You will need to keep your scheduled follow-up appointments with the doctors, nutritionists and exercise specialists in order to make sure you stay healthy.You will need to continue to eat nutritious foods and exercise 3-6 times a week. You will need to chew food thoroughly, drink at separate times from meals, and take your vitamins and other prescribed medicines. You can expect to eat only about 2 ounces at first but eventually will be able to eat 4-6 ounces at a meal. You will not be able to drink sugary, carbonated or caffeinated drinks. It will take several months to reach the “after surgery” diet.

What will I need to do before the surgery and what do I bring with me the day of surgery?You will be given instructions for the day before surgery. This will include having only clear liquids the day before surgery and also taking a laxative. You only need to bring comfortable clothes for travel home after you are discharged. You do not need to bring jewelry or money.

When will I be able to go home?You should be able to go home on the second day after surgery.

What diet changes should I make after gastric bypass surgery?Immediately after surgery: On the first morning after surgery, you will be started on a clear liquid diet. You will quickly advance to full liquids.Stomach size: Your new stomach is about the size of an egg and can only hold a few spoonfuls at a time. Food and drink: During the beginning stages of the diet you will need protein supplements and special shakes to help you meet your nutritional needs.

You will not be allowed to drink sugary, carbonated or caffeinated beverages. At first you will need to eat frequent small meals throughout the day to help meet nutritional and fluid requirements. It will take several months of very specific meals plans before the real diet is reached.Vitamins: After surgery, your body will not be able to use and absorb all of the nutrients provided by food. Therefore, vitamin and mineral supplements will be necessary every day for the rest of your life. It is very important to take these to avoid dangerous medical problems.

What care will I need at home after surgery?Care of the incision: There will be about 5 small holes. There will be specific instructions about bathing given to you by your nurse. Activity limitations: You will not be allowed to do any heavy lifting (nothing over 5 pounds). You may tire easily but otherwise you may go back to school as soon as you feel able.Bathing: You may shower as soon as you like unless your incisions have been closed with skin glue. Please check with your nurse before showering.Medication: When done laparoscopically (using tiny telescope-like instruments), there is minimal pain after the surgery. By the day after surgery, pain at the incision sites is managed by liquid Tylenol or an oral, mild narcotic. If you have pain that does not get better with these medications, or if you are having severe pain, please contact your surgeon’s office immediately.

How much time should my parents plan to be off work and when can I go back to school?Your parents should be able to go back to work within 3-4 days. You will be independent in walking, bathing and self-care when you get home from the hospital. Most teens return to school within a week after surgery.

When should I call my surgeon?If you cannot stop vomiting. If you have nausea (feel sick to your stomach) that will not go away.Fever of 100.5°F or aboveRedness, swelling, increased pain and/or pus-like drainage from any of your incisions.Pain, redness and/or swelling in your legs.Chest pain and/or shortness of breath.Urine output less than four times in 24 hours.Pain that is unrelieved by pain medications.

Please reproduce and distribute this sheet to your surgery families. This teaching sheet can also be downloaded at www.APSNA.org.Copyright 2006, Beverly Haynes. Copied with permission by Jones and Bartlett Publishers, Sudbury, MA.